Provider Demographics
NPI:1568560829
Name:ODOCHA, INNOCENT N (MD)
Entity Type:Individual
Prefix:DR
First Name:INNOCENT
Middle Name:N
Last Name:ODOCHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 NE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-3339
Mailing Address - Country:US
Mailing Address - Phone:352-371-3212
Mailing Address - Fax:352-371-3213
Practice Address - Street 1:605 NE 1ST ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-3339
Practice Address - Country:US
Practice Address - Phone:352-371-3212
Practice Address - Fax:352-371-3213
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86683207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57823AMedicare PIN